This revised application introduces Judith Mercer, CNM, DNSc, an Associate Professor, College of Nursing at University of Rhode Island, an experienced nurse-midwife committed to a career in patient-oriented clinical research. Her research goal is to examine the beneficial effects of delayed cord clamping on the neonate's physiologic adaptation and neurodevelopmental outcomes. Delayed cord clamping allows for more placental transfusion and has been found to improve cardiopulmonary adaptation, increase pulmonary vasodilatation, lower vascular hinderance, and prevent hypovolemia and anemia. In preterm infants, delayed cord clamping has resulted in fewer transfusions, fewer days of oxygenation and ventilation, higher blood pressures, and higher hematocrits. It is critical to understand the effects of delayed cord clamping on the neonatal outcomes in preterm infants. The hypothesis is that very low birthweight infants (VLBW) infants who have delayed cord clamping (30 to 45 sec) will have less chronic lung disease, less suspected necrotizing entercolitis, and better neurodevelopmental outcomes when compared to a group of VLBW infants who have early cord clamping (< 5 sec). A K-23 award would provide Dr. Mercer with the funding and time to conduct this critical research and to pursue extensive training in neonatal physiologic research, statistical analysis and research design, and an internship with the Infant Development Center on functional and neurodevelopmental outcomes in preterm infants. The University of Rhode Island, Brown University, and Women and Infants' Hospital, the clinical site for this research, offer support. Activities in the career development plan include 1) course work in statistics and research design at URI; 2) seminars, rounds and specialty conferences at Women and Infants' Hospital along with multidisciplinary fellows and residents; and 3) expert mentoring in further study of neonatal physiology and developmental research. The study will build on Dr. Mercer's preliminary work and will explore differences in morbidity rates and early developmental outcomes of the infants through seven months corrected age implemented through the Infant Development Center and the Department of Pediatrics at Women and Infants. These studies will establish if there is enough evidence to support the practice of delayed cord clamping in preterm infants. This project will provide the foundation for further research in larger preterm and term infants. [unreadable] [unreadable]